RBR Subcontractor Qualification Form

We appreciate your interest in becoming a subcontractor for RBR Construction.  In order to determine your qualifications we require you fill out the form below completely.  When you finish filling out the form press submit.  Your request will be forwarded to the proper person within RBR.

Note:  RBR Construction does not accept solicitations or job applications through this web site. 

Please begin by providing us with the following contact information, use the TAB key to move to the next field. (areas in blue indicate required information, areas in grey are not required but highly recommended.)

Firm Name & Contact Information: areas in blue indicate required information

Firm Name:
Project

Date(MM/DD/YY):

Contact Name:
Type of Firm Select one: Corporation   Partnership   Sole Proprietor    Other
Contractor License Number

State License is held:
Street Address
Address (cont.)
City

State
Phone  

FAX

Zip/Postal  code
E-mail

Trades Performed (for example, concrete, dry wall, etc.)areas in blue indicate required information

Trades Performed:


Bonding:

Surety Company:
Agent Company:
Agent Contact: Phone:
Your Bonding Capacity (Dollars): Value Presently Bonded (Dollars):
 

Insurance: areas in blue indicate required information

Insurance Company:
Agent Company:
Agent Contact: Phone:

Safety:
Bureau of Labor Statistics (BLS) Standard Industry Code:

Year

2003 2004 2005
Worker's compensation experience modification rate for last three years.
Lost workday cases for last 3 years as recorded on OSHA Form 200, total of columns 2 & 9
Number of recordable injury/illness cases for last 3 years - OSHA recordable totals, OSHA Form 200 total of columns 1, 2, 6, 8, 9, & 13
Employee hours worked for last 3 years (do not include any non-work time even though paid).

areas in blue indicate required information
Have you had any OSHA fines within the last three years? Yes   No
Have you had any jobsite fatalities within the last three years? Yes   No

If you answered YES to either of the above 2 questions, you MUST submit on a separate sheet the details describing the circumstances surrounding each incidence and fax the pertaining information to our offices at 817.341.0969, Attention: Jason Ringo or by email to jringo@rbrconstruction.com

Provide 3 References: areas in blue indicate required information
1st Company:
Agent Contact: Phone:
 
2nd Company:
Agent Contact: Phone:
 
3rd Company:
Agent Contact: Phone:


 

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P.O. Box 550   Weatherford, Texas  76086   Voice 817.341.1467    Fax 817.341.0969
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